FROM Kaiser Family Foundation: The Foundation has issued its latest global health survey, Views on the U.S. Role in Global Health Update, which probes American public opinion about efforts by the United States to improve the health of people in developing nations. According to the poll findings, most Americans support current U.S. spending to improve health conditions in poorer nations despite the economic recession. Two thirds of the public supports maintaining (32%) or increasing (34%) spending on global health, while a quarter say the country is spending too much. More of the public prefers an emphasis on health infrastructure rather than fighting specific diseases. When asked to rank the importance of the two approaches, 58 percent say it is more important to emphasize programs that help countries build their health system infrastructure, under the theory that stronger health systems can better handle a variety of problems. In contrast, 36 percent say it is more important to emphasize efforts to fight specific diseases like AIDS and malaria because efficient methods for treating such diseases already exist and can save large numbers of lives. All the survey materials are available online.

This is interesting and great news given our economic climate that the majority of Americans still care deeply about helping those with the fewest resources worldwide. I find intriguing that the American public has marched forward from embracing the issues of HIV/AIDS and the global pandemic, or malaria and the need for bednets, to realizing the need for health systems, working together, to build infrastructure for smart, efficient use of assistance. Health systems and health infrastructure are far from sexy topics, but that is what is needed and needed now.

by Bill Frist, M.D.

A couple weeks back, the Living Proof Project was unveiled in Washington, D.C. by Bill and Melinda Gates. The goal of this great project is to share the good news of the implementation of assistance. U.S. investments in improving global health are delivering real results. From significant declines in child deaths, to global eradication efforts against polio, to insecticide-treated bed nets that reduce malaria transmission, global health initiatives are working. At http://www.gatesfoundation.org/livingproofproject you can learn more from their progress sheets. Watch the speeches of these "Impatient Optimists."  I have the pleasure of serving on the Advisory Council.
 
The video below was shown yesterday at a Save the Children Survive to Five Council meeting in NYC. This is a great example of real results, combating infant mortality. Saving the life of a little one.

 

The end of October marked the end of my first quarter here at Africare and the start of the second quarter seems to have brought with it all types of change. In the office we are currently in the midst of several big changes, the biggest being the addition of a new CDC funded home-based care project. Africare will work with some small Civil Service Organizations and existing community structures to provide home-based care for people living with HIV/AIDS. The start up of this project has required a lot of time and energy, including interviewing for about 20 new positions. With between five and ten candidates being interviewed for each position, you can imagine that this has been a very time consuming process. Everyone from the Country Representative, to the program's Chief of Party, to the junior staff has been pitching in to assist in the interviewing process. I've been working very closely with the Human Resources Officer to test the candidates' practical skills, compile summaries of interview results, and create briefings of panel recommendations to be reviewed and approved by the Country Representative and our headquarters in Washington, D.C. I even had the opportunity to sit on the interview panel for a few of the positions and it was quite a different experience being the interviewer instead of the interviewee. One of the new staff that has been hired is the new Program Assistant, Gloria.

by Bill Frist, M.D.

Yesterday morning, I had the honor of speaking at both services at Christ Church in Nashville. Over 5000 people attended. The services were dedicated to the doctors and nurses in the community, recognizing all health care workers for their healing care. It was a wonderful opportunity to share the work of Hope Through Healing Hands at home and abroad. As you know, HTHH's selects Global Health Leaders, annually, to travel to underserved clinics around the world to bolster health care and training of community health workers for sustainability. Right now, we have Leaders in Tanzania, Rwanda, Kenya, and Guatemala. We are proud to support their efforts, using health as a currency for peace. As Martin Luther King, Jr. said, "We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly affects all indirectly."

Thanks to all at Christ Church for the warm welcome.

 

 

Today, I joined Save the Children, the US Coalition for Child Survival, the World Pneumonia Day Coalition and Vicks at a breakfast reception on Capitol Hill to recognize the first annual World Pneumonia Day, a day for people everywhere to turn awareness into action to control the #1 killer of children under age 5: pneumonia. Each year, a disease which often starts as a cold, claims the lives of nearly 2 million children under age 5 -- more than malaria, AIDS and measles combined. Despite this staggering death toll, childhood pneumonia has never been a global health priority, and the current basic maternal child health programs --that need to be in place to control the disease-- are under-funded.

by Jenny Dyer

November 4, 2009

How can art save the world? Photographers have the gift to capture a moment of beauty. And, capturing moments of beauty for a person who has never known s/he is beautiful, can give life back to the most downtrodden of spirits--proving everyone holds a spark of the imago dei.

Jeremy Cowart wondered how he could give back, offering his gift of capturing the lovely in those who may have never seen that loveliness. His Help-Portrait movement has sparked interest around the world to provide photos to those individuals and families in need. His website provides the tools to do the following:

1. Find someone in need

2. Take their portrait

3. Print their Portrait

4. And Deliver Them.

If you're a photographer -- check out this movement. Your art could change the world. Consider joining the community:

What does Help-Portrait Look Like?

 

"Henceforth, simply the nappy."

One of the most delightful things about being in Kenya is participating in the odd mix of African bush culture and English propriety. It's what remains of the colonization of this land by the British, I guess. And it is quite nice.

For example, we all have dusty feet peering out of rubbery ‘flip-flop' like sandals in the operating area, yet we refer to the OR's as ‘theatres', and we adjourn to ‘take tea' at the proper intervals throughout the day. The Kenyans put every coffee house in the developed world to shame with their ‘chai': a creamy, sweet cup of goodness scooped from a boiling pot of tea leaves and milk, fresh from the cow, brought to the hospital that morning in a plastic bucket. It is just so very civilized and so very African. And it is mandatory, I am beginning to understand. In this picture, you can see me having tea with some of the nursery and maternity nurses. I had just given them a lecture about neonatal warning signs in the delivery room, and I was prepared to whisk away to the days doctoring tasks. They insisted that I sit and have tea. It's the proper, Kenyan way.

The influences of the Queen's English and Kiswahili also manage to trip me up on a daily basis. Example 1: intern says to Dr. Amy, "this preterm is receiving 8ml feeds, two hourly, and is retaining." Dr. Amy blinks thinking, "retaining? Is retaining good or bad?" Example 2: same intern pouts over a squeaking, stridorous baby. "Oh, he is lamenting," she says. And I think, "man, I wish I used the word lamenting." Example 3: A few days ago I noticed that there was an odd pile of gauze taped around baby Hawa's ostomy which was causing the liquid stool output to severely irritate his skin. So I asked one of the nurses, "could we stop using the dry gauze and only use a diaper from now on?" The nurse replied, "So, henceforth, simply the nappy?" "Uh, yeah, simply the nappy. Thanks."

Perhaps my favorite experience yet should have a photo but I must try words instead. I was chatting with Dr. Gary in the hospital corrider, and as we were talking, a Masai grandmom walked past with her infant grandson in a sling on her back. The little guy was healing from a chemical burn of his head, and he had even lost most of his left ear. After multiple skin grafts he still had bright pink under-flesh covering most of his head. It was a patchwork that looked like freshly groomed farm land: little squares of different soils in pinks and browns. His grandmom was covered in beads, ear lobes hanging low from a piercing type process, dark black feet flat against the hospital floor and the little guy, peering up to catch our eyes... then he giggled and hid from us in the folds of his grandmother's clothes. His happiness took over the air around us. I could not understand how such a little boy (two years old) could have so much pain-- so much to cry about -- and yet so much joy! Later I found out that this patient, Ralian, is Jim's patient. Jim is his surgeon, and he is Jim's favorite. Ralian's grandmother has said that she wants to return to visit us before we leave so she can give Jim a reward for taking care of her grandson.

So far, I have been blessed to enjoy my time here in ways I could not have foreseen. It is simply "well with my soul," as the old hymn says. And still, I am a creature of luxury, and I miss all the lavishness of my home in Colorado. Gary Finke, the pediatrician of the past 2 years, leaves roughly the same time we do. So as the days march forward and we get closer to hugging our families, our friend Stephany gets closer to being the sole pediatrician at this busy children's hospital. Her fear of taking on this mighty task is always behind the scenes. She is weary, and it is hard to leave her behind. I am asking now, reader: please pray for reinforcements for Stephany. Pray for courage and joy and wisdom and sleep for her. If you are a pediatrician - consider coming to help her. Even just a few weeks would lessen the load and give little lily pads of rest during her 2 year commitment. You will be a blessing and you will be blessed!

I have a tendency to count down days until the end of different periods of life. A physician in Nashville once advised a group of us not to wish away our lives during residency, and I hate to admit that I sometimes have that tendency, although not just in residency. Recently I have been simultaneously struggling to not count down the days until I return to my own indulgences (warm bath, constant electricity, reliable phone line to call mom and dad) and dreaming of returning to live out my days here.

I said in a previous post-my first post from Kijabe in fact-that life here is simple, hard and lovely. It is simple, and it is hard in many ways. That is true. But in the end and above all, life here is lovely.

 

 

  

1) Patient Beds

2) Hospital Compound where families clean clothes and make food for patients

3) Ingredients for Hand Sanitizer

It has been one month since I arrived in Rwanda and I am continually amazed at the obstacles my patients and coworkers face. The work can be very frustrating. Everyday I see ways to keep people alive and reduce the severity of illnesses, but implementing change is never easy, especially when resources are extremely limited.

One particular frustration is the lack of hand washing by the medical staff. An estimated 60,000 in Rwanda are infected with illnesses in hospital, which are called nosocomial infections. Nosocomial infections are often caused by health providers not having properly washed their hands. They significantly increase patient death rates as well as costs to the patient and hospital. I have seen diseases being spread in our hospital and the staff seems to accept it as normal.

All the nurses and physicians know they are supposed to wash their hands between patients, but it just is not practical. There are no sinks in the patient rooms and the nurses have to move quickly from one patient to the next to provide care for everyone. There is only one sink per floor, and it is located very far from the patients. A great majority of the patients have infectious diseases such as HIV, tuberculosis, intestinal parasites, and infectious hepatitis, so hand washing is especially important.

After two weeks of frustration I found a solution. Hand sanitizer is an effective way of killing most germs and does not require running water; unfortunately it is too expensive for the hospital to purchase. With some research I found some recipes for homemade hand sanitizers that costs a fraction of the price of commercial products yet are effective disinfectants. I tested recipes until I found one the staff members like the most. I am now working with the chief of nursing to ensure that the hospital can afford to make it in sufficient quantities indefinitely. This is only a small change but I believe it will result in a significant reduction of infections passed from patient to patient and to the workers themselves. My hope it that they not only continue to use the hand sanitizer but that this will begin to instill confidence that there are ways we can start to limit unnecessary hospital born infections.

 

 

Global Health Essay Contest

October 23, 2009

The Center for Strategic & International Studies Commission on Smart Global Health is calling for essay submissions. The essay seeks to answer the vital question, “What is the most important thing the U.S. can do to improve global health over the next 15 years?”

Essay submissions must be between 500 and 800 words are due at midnight EST on November 20, 2009. CSIS is so dedicated to answering this question that they are offering a $1,000 scholarship for the winning essay.

We encourage you to submit your philosophy and your thoughts on how the U.S. can improve Global Health, ultimate to aid in achieving the Millennium Development Goals.

Spread the word. Tell your friends.

Check out the Smart Global Health website for more details.

Saving a Life: Meet Olken Foncime, a Haitian Orphan

 

By Jenny Dyer

 

  

           

     

Christian Gilbert, M.D., Associate Medical Director of International Children's Heart Foundation (www.babyheart.org) in Memphis, TN connected with Senator Frist about a year ago to let us know the great work he was doing: providing pediatric cardiac surgical services and education to the children and health care providers in developing countries around the world.

 

We invited the International Children’s Heart Foundation to join the HTHH Tennessee Global Health Coalition, and he and his wife attended our first Gathering at the First home September 29, 2009. I had been apprised by Senator Frist of a situation in Haiti, where a young orphan, Olken, was suffering from congenital heart disease, Tetralogy of Fallot, and would likely die without immediate surgery. In meeting Dr. Gilbert for the first time, I asked him what the likelihood of his reaching this child in rural Haiti would be.

 

I’ll let Christian relay the rest of the story through his letter:

 

Jenny,
This story begins with a letter to Senator Frist which you answered and as a result invited me and ICHF to participate in the HTHH foundation. That led to an invitation to the gathering at the Senator's house. There I found out about this Haitian orphan in need of heart surgery from you.

 

I checked it out with my director and the director of the program in Dominican Republic, where I was headed for a two week mission and got the OK to help him on our mission to the DR later in the week. That set the wheels in motion and before too long I had pictures of him and his caretakers and knew his name, Olken Foncime.

 

He arrived in the Dominican Republic on Wednesday the 7th of October with his guardians, Marc, Leslie, and Pauline. When I first met him I was stunned at the profound degree of cyanosis, and equally impressed by his gentle sweet demeanor. He quickly became everyone's favorite. He was a high risk surgery with an estimated mortality risk of 15-20%. I reminded myself that it was 100% without it. He needed some things done before we could operate on him such as antibiotics and exchange transfusions because his hematocrit was 80, with normal being around 40. His blood coagulation was so abnormal the anesthesiologists was reluctant to put him to sleep for the IV line to do the exchange transfusion. Because he was so sick it was decided that rather than try a complete repair which carried a very high mortality risk I would do a shunt procedure and defer the total repair for a time when he was not so sick and had a better chance of survival.

 

On Monday October 12th he was taken for a Blalock Taussig shunt. He did very well with the operation and for the first time in his life he had pink nail beds and lips. In the picture, he is bravely holding onto his teddy bear and heart just a few hours after his surgery.

 

 

      

 

He is now 3 days post op and is starting to open up and smile and eat some food. All of his IV lines and drainage tubes are out and he has been transferred to the regular ward. It is my expectation he will be ready to return to the orphanage on Saturday or Sunday. I hope that some time in 2010 we will be able to bring him back for a total repair. We all have been blessed by this child and his caregivers who demonstrate amazing love and selflessness. God put us together and I give him all the glory as we are simply his servants here on earth. He clearly has a plan for this beautiful little boy. Thank you for bringing his story to my attention. God Bless.

 

Christian

 

…Sometimes little miracles happen through the most simple of circumstances. Building partnerships is crucial for saving lives, like Olken's, around the world. This is just the beginning of what is possible with a robust, well-connected coalition...

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